Knowing that health and education are intertwined, it only seems natural that alongside classrooms, libraries and cafeterias, schools would offer access to full-service health centers.
In the Bronx, health care professionals have been doing just that, making a difference for underserved children through school-based health centers (SBHCs).
“These clinics provide a critical service to a critical population at a critical time in their lives,” says David Appel, director of school health programs for Montefiore Medical Center.
SBHCs, he says, help eliminate health disparities by addressing the medical, dental and mental health challenges facing Bronx children and adolescents, particularly those without health insurance or a primary physician. Parents and students have access to care and to learn how to prevent illness and stay healthy.
With teen pregnancy a particular concern in communities like the Bronx because of its connection to poverty, the clinics also provide adolescent students with confidential reproductive health services. This includes sex education, contraception—including long-acting contraception—pregnancy testing and screening for sexually transmitted infections such as HIV.
Montefiore—which runs the largest school-based health program in the country—is one of five health organizations partnering with the New York City Department of Education to improve health outcomes and reduce health disparities for tens of thousands of Bronx children. In addition to Montefiore’s 23 SBHCs, an additional 30 others are operated by the Morris Heights Health Center, Urban Health Plan, New York Presbyterian Hospital and Morrisania Diagnostic and Treatment Center.
One of Montefiore’s newest SBHCs is housed at the New Settlement Community Campus in the Mount Eden neighborhood that includes an elementary, middle and high school. A physician and nurse treat the usual colds, cuts and scrapes, but also provide more in-depth medical exams while helping students manage chronic illnesses such as asthma or diabetes. A mental health counselor addresses conditions such as anxiety or depression. A dentist provides oral care twice a week, and a community health educator offers families, teachers and students advice on how to eat healthier and enjoy active lives.
Montefiore covers the approximately $200,000 startup cost for each SBHC it administers. After that, services are covered through public funding, with 70 percent from Medicaid and 30 percent from federal, state and city grants.
The results have been remarkable. One Montefiore study showed that students in schools with an SBHC have half as many emergency room visits as children in schools without them. It also found that asthmatic children in schools with an SBHC are half as likely to be hospitalized as those without them.
At one high school SBHC, Montefiore reported a 40 percent decline in positive pregnancy tests over four years. Morris Heights Health Center, a federally qualified health center that administers 17 SBHCs, started a “Changing the Odds” project that taught students about relationships, adolescent development and sexual health. The program reduced risky behaviors while improving academic performance and attendance.
Of SBHCs, Appel says, “It’s been established that this makes sense.”